Original article Relationship of evening meal with sleep quality in obese individuals with obstructive sleep apnea Camila Maria de Melo a, b, * , Mariana Pantale ~ ao del Re a , Marcus Vinicius Lucio dos Santos Quaresma c , Hanna Karen Moreira Antunes c , Sonia Maria Togeiro a , Sandra Maria Lima Ribeiro b, d , Sergio Tufik a , Marco Tulio de Mello a, e a Department of Psychobiology, Universidade Federal de S~ ao Paulo, Brazil b Interunits Program of Human Nutrition, Universidade de S~ ao Paulo, Brazil c Department of Biosciences, Universidade Federal de S~ ao Paulo, Brazil d School of Public Health and School of Arts, Sciences and Humanities, Universidade de S~ ao Paulo, Brazil e School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Brazil article info Article history: Received 18 September 2018 Accepted 30 September 2018 Keywords: Sleep apnea Obesity Food intake Energy expenditure Meal distribution summary Purpose: To determine the relationship between habitual food intake, resting energy expenditure and sleep pattern in obstructive sleep apnea (OSA) patients. Methods: Forty-five OSA obese males were included in the study. All participants were submitted to nocturnal polysomnography, body composition measurements by plethysmography, resting energy expenditure (REE) analysis by indirect calorimetry and they filled in a 3-day food record. Results: No differences in body composition, REE and food intake were found between the moderate and severe OSA groups. A trend towards higher energy intake in the severe OSA group was observed, compared to the moderate group (p ¼ 0.08). Significant associations between apneaehypopnea index (AHI) with body weight, body mass index (BMI) and resting energy expenditure (REE) were found. Higher food intake in the evening period was positively correlated with sleep stage NREM1, arousal index, and AHI and negatively correlated with sleep stage NREM3 and sleep efficiency. A multivariate linear regression showed energy intake at breakfast to be a significant negative predictor of AHI; protein intake (g/kg) showed a positive association, while energy intake at breakfast and at dinner were negative predictors of sleep efficiency; and energy intake at dinner was a negative predictor of stage NREM1 sleep. Conclusions: We conclude that higher amounts of food intake during the evening period may diminish sleep quality in moderate and severe sleep apnea patients. In addition, despite observing no differences between OSA severity groups, a moderate correlation between REE and sleep quality and OSA exists. © 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. 1. Introduction Obstructive sleep apnea (OSA) and obesity are tightly related [1]. Peripheral and visceral fat accumulation predisposes and increases OSA's severity through anatomical changes in the upper airway and increased metabolic and humoral factors released by fat, such as leptin and inflammatory cytokines [2]. Treating obesity in OSA patients improves disease severity and comorbidities [3]. A po- tential association between energy balance and sleep-disordered breathing is also discussed in the literature. OSA may favor a pos- itive energy balance, contributing to the development of obesity [4]. The fragmentation of sleep that is caused by OSA may lead to excessive sleepiness and lower energy expenditure (EE) during the day, which is associated with a higher energy intake, contributing to weight gain and obesity development. In recent years, energy intake and the distribution and regu- larity of meals have been discussed [5,6]. Hermengildo et al. [7] showed that the practice of ingesting a higher percentage of daily energy at lunch and a lower percentage at dinner is * Corresponding author. Department of Psychobiology, Universidade Federal de S~ ao Paulo, Rua Botucatu, 862, S~ ao Paulo 04023-062, Brazil. E-mail address: camariamelo@gmail.com (C.M. de Melo). Contents lists available at ScienceDirect Clinical Nutrition ESPEN journal homepage: http://www.clinicalnutritionespen.com https://doi.org/10.1016/j.clnesp.2018.09.077 2405-4577/© 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. Clinical Nutrition ESPEN xxx (2018) 1e6 Please cite this article in press as: de Melo CM, et al., Relationship of evening meal with sleep quality in obese individuals with obstructive sleep apnea, Clinical Nutrition ESPEN (2018), https://doi.org/10.1016/j.clnesp.2018.09.077